Automatic tracking of target treatment sites within patient anatomy

ABSTRACT

During a medical procedure, a system and method facilitate identification and treatment of sites within patient anatomy. A digital image of a region of patient anatomy is captured and displayed on a digital display. Target treatment sites are tagged with respect to the image, and overlays identifying the tagged target treatment sites are displayed. As tagged sites are treated, the corresponding overlays are removed, altered or replaced to indicate the tagged target treatment site has been treated.

BACKGROUND

In a surgical procedure, it is necessary for the surgeon to keep track of the regions within the patient anatomy that are to be treated. For example, during surgery to treat endometriosis, the surgeon will want to remain aware of endometriosis lesions that s/he wishes to treat before concluding the procedure. In other types of surgery, the surgeon may want to keep track of lesions, regions of abnormal tissue, tumors, etc. for treatment or evaluation.

In some procedures, there may be a relatively large number of regions to keep track of numerically, and the regions may be spatially and visually dispersed at the treatment site. The practitioner maneuvers the endoscope within the surgical field to identify the areas of interest, such as by zooming the camera in/out and moving it around in the surgical field, but must rely on spatial memory to track where the regions to be treated are with respect to other anatomy or other target regions. At times, other anatomy within the surgical site may move and occlude visualization of these regions to be treated.

This application describes a system for planning, executing, and providing cueing information to the user, in each case relating to assessment and/or treatment of identified regions or sites within the surgical field, ensuring that clinical metrics with regard to those regions/sites are satisfied.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a sequence of steps schematically illustrating a first embodiment of thedisclosed method.

FIG. 1B is a sequence of steps schematically illustrating a second embodiment of the disclosed method.

FIG. 2A shows an image of a treatment site as captured by an endoscopic camera and displayed to a user on a display and shows endometriosis lesions at the treatment site.

FIG. 2B is similar to FIG. 2A but shows an overlay on the displayed image. The overlay shows colored regions overlaying the endometriosis lesions.

FIG. 3 is similar to FIG. 2B but shows the display following enlargement of the image (“zooming in”) by the user, either using camera movement, optical zoom, or digital zoom. A characteristic of the overlays (e.g. color, pattern, outline characteristics, etc.) is changed on the display after lesions are treated.

FIG. 4 is similar to FIG. 3 but shows the site after the camera has been “zoomed out.” Both treated and untreated lesions are shown with their respective overlay types.

DETAILED DESCRIPTION

In general, a system includes an image capture device such as a camera for capturing images of a treatment site, an image display for displaying the images, at least one processor for receiving the images and which includes a memory storing instructions for executing the various features described here, and a database associated with the processor. User input devices may also be included, such as, without limitation, vocal input devices, manual input devices (e.g. buttons, touch inputs, knobs, dials, foot pedals, eye trackers, trackers etc.). In some configurations, the system is used with a robot-assisted surgical system, in which case the input devices may be part of the surgeon console used by the surgeon to give input to the surgical system to command movement and actuation of surgical instruments carried by robotic manipulators.

In accordance with the disclosed method, areas within the treatment site that are targeted for treatment are entered into a database. Real time images captured during the treatment procedure are displayed on an image display, and graphical overlays are displayed on the image display to visually mark the areas. During the course of treatment, the system tracks the areas to be treated, and, preferably but optionally, also tracks the areas that have been treated, in some cases changing characteristics of the overlays of treated sites so the user may easily distinguish between sites that have been treated and sites that are yet to be treated. Treatment for each region is updated and tracked during the course of the procedure. Feedback on each tracked region (e.g. indicating that it has been treated) is provided to the system. Feedback on each tracked region is provided to the user, such as using the overlays described above, which appear different depending on whether the site is treated or untreated.

To enter the areas for treatment (also referred to as “target areas”) into the database, a scan of the relevant anatomy is input to the system. This may be a single scan or multiple scans, which may be sequential. In one embodiment, the scan is captured during the course of the treatment procedure using a camera or other form of imaging device positioned in a body cavity to image the relevant anatomy. In other embodiments, the scan is a pre-treatment scan captured using an endoscope or other type of imaging system. For convenience, this description focuses on the use of an endoscopic/laparoscopic camera for capturing the scan.

Areas for treatment captured by the scan image data are identified or tagged relative to the scan in one or more of a variety of ways. As a first example, a user viewing the scan on an image display identifies the areas to the system. Non-limiting examples for this include:

-   -   Touching the areas on a touch screen displaying the scan (which         as mentioned may be a real time image of the site) using a         finger or stylus.     -   Navigating a physical pointing device, which may be a medical         instrument, to the area for treatment within the treatment site,         to identify the area to the system. In this example, the         position of the instrument may be identified using computer         vision that “sees” the medical instrument in the image and         records its position with respect to the image, or, if the         medical instrument is maneuvered by a robotic manipulator it may         use kinematic data from the robotic system or some combination         of image data and kinematic data.     -   Navigating a virtual pointing device that is shown on the image         display, such as an arrow icon, using a user input device such         as a mouse, touch pad, eye tracker, head tracker,         multi-degree-of-freedom input device, or an input device used to         control manipulators of a robotic surgical system. The virtual         pointing device might also be displayed a predetermined distance         from the tip of an instrument within the treatment site (i.e.         imaging processing is used to recognize a part of the instrument         such as its tip or jaw clevis), and the user moves the virtual         pointer by moving the instrument.

Each of the above examples may optionally include a subsequent step of confirming the locations to the system using a confirmatory input such as a voice command, button press, foot pedal press, or some other form of input.

As a second example for identifying areas for treatment relative to the scan image, image processing may be used to recognize types of abnormal tissue, such as endometriosis lesions, tumors, or others. In this example, the system might generate graphical overlays (e.g. highlighting, shading, bounding, arrows, etc.) marking the regions it has identified as being potential treatment areas of the type the user is seeking to identify. As a subsequent, optional, step, the user may be prompted to confirm that the marked regions are treatment areas to be tracked during the procedure. The types of user input that could be used for this purpose include but are not limited to those discussed above.

In a third example for identifying areas for treatment relative to the scan image, the user might use the input methods discussed above to identify a region to the system, and the system might then perform image processing to identify the endometriosis lesions or other target tissues within the identified regions.

Tagging may occur at the beginning of a procedure but may also occur during a procedure as new targets are identified.

Overlays generated and displayed on the image display are preferably used to visually mark target areas identified using any available methods, including those discussed above. As non-limiting examples, the system might generate graphical overlays such as highlighting, shading, bounding, arrows, etc. marking the target areas. The overlays are tagged to image data. As the user moves the endoscope around the relevant anatomy, some tagged target sites will be off-screen at times, but they and their corresponding overlays will reappear when the endoscope returns to a position in which those tagged target sites are within the displayed field of view.

The target areas are then treated using the type of instrument suitable for treatment of the treatment areas, such as devices for excision, vaporization or cauterization of abnormal tissues such as endometriosis lesions. The treatment might be one directly performed by the user using manual laparoscopic or surgical instruments or using robotically manipulated instruments maneuvered and actuated in response to user inputs at a surgeon console. In other implementations, the treatment is carried out using a robotic system while the user provides supervisory oversight in a supervised autonomy mode or in a semi-autonomous procedure. In still other implementations, treatment is part of a fully autonomous surgical procedure which makes use of the recognition and tracking features described in this application.

In preferred systems, the overlays marking the treatment areas are updated or altered to differentiate as-yet untreated target areas from those that have been treated. This might include a change in color, shading, border color, thickness, or characteristics (e.g. dashed vs continuous), addition of a particular graphical overlay (e.g. a checkmark), removal of the overlay altogether, etc.

Input to the system as to whether a target area has been treated can be given by the user, or the system can determine that a given target area has been treated. In the former example, the user can identify treated areas to the system using input methods of the type described above, allowing the user to directly “check the items off a list” as treatment is performed via an input device.

In the latter example, computer vision may be used to determine that treatment has been performed via a variety of means, such as, but not limited to:

-   -   Change in color of the tissue at the target site (i.e. detecting         eschar from a cauterized lesion)     -   recognition of the presence of predetermined treatment         instruments above the tracked target for a certain period of         time and/or moving in accordance with motions predetermined and         known by the system to be those used for the relevant treatment     -   Recognition of the presence of predetermined instruments above         the tracked target, together with input from, for example, a         processor associated with an electrosurgical unit or laser         system indicating that the instruments have been energized or         operated.

Visual feedback to the user may additionally present metrics indicative of the progress made towards completing treatment of the identified sites. For example, the visual display may present a metric such as “10 of 30” or present a graphical “progress bar” (indicating the number of sites treated out of the entire number of identified target areas), with the metric updated during the course of the procedure.

Simple flow diagrams illustrating exemplary methods are depicted in FIGS. 1A and 1B. The example illustrated in FIG. 1B includes the following steps, using the specific example of endometriosi s lesion treatment.

-   -   Overall scan, or sequential scan is input to the system     -   Endometriosis lesions are identified         -   Identified, tagged by user         -   Identified, tagged by CV/AI (with or without user             confirmation)     -   Tagged     -   Provide visual overlay onto each lesion     -   Update display and database of tracked lesions as their status         changes

In alternative method depicted in FIG. 1A, the treatment site is subjected to a pre-scan, targets are identified, treatment is performed, and then the area is re-scanned, after which the system shows confirmation of treatment in the treated areas.

A representation of the user interface and the progression of the feedback provided to the user are shown in the sequence of images shown at FIGS. 2A-4.

FIG. 2A shows an example of an endoscopic view of a region of patient anatomy as displayed on an image display. Endometriosis lesions are visible as dark spots on the tissue.

FIG. 2B shows the image of the region after overlays have been added to the image display to mark the lesions that are to be treated.

In preparation for treating some of the lesions, the user may at this stage decide to enlarge a particular region of the anatomy on the image display by moving the camera closer to the tissue or operating a zoom function associated with the camera or vision system. FIG. 3 shows the view zoomed-in so the region bounded by the dashed rectangle in FIG. 2B is enlarged on the image display, after the user has treated the identified lesions within that field of view. The visual appearance of the overlays within the view has been changed to mark them as having been treated. In this example the change is a color change from bright green (marking un-treated lesions) to dark purple (marking treated lesions).

In FIG. 4, the view has been zoomed back out to the view shown in FIG. 2B, and so the untreated lesions outside the view of FIG. 3 as well as their overlays have come back into view. The untreated lesions remain marked by overlays representing untreated lesions, while the treated lesions remain marked by overlays representing treated lesions.

To expedite movement between treated and untreated lesions, and to ensure all identified lesions are treated, the system may be optionally configured to receive a command from the user to show untreated lesions remaining in the anatomy. In response, the system might alter the field of view displayed on the image display by showing a portion of the captured image that is outside the field of view currently being displayed (e.g. by automatically zooming the image out, or by physically moving the camera in pan and/or zoom). Alternatively, directional graphics may appear on-screen pointing the user to a direction relative to the displayed image, indicating that untreated lesions are presented in that direction relative to the displayed image. This allows the user to move the camera or adjust the image to display the region in the indicated direction so s/he can view and treat the untreated lesions.

The disclosed system and method provide the advantages of enabling the tracking of regions requiring treatment and as well as their change in status once treated, giving live overlays and simultaneous tracking of regions requiring treatment outside of the user's current field of view. This assists the surgeon with direct, real-time feedback that can enhance the efficiency of the treatment procedure. 

What is claimed is:
 1. A medical treatment method comprising the steps of capturing a digital image of a region of patient anatomy; displaying the digital image on an image display; tagging target treatment sites with respect to the image; displaying overlays identifying the tagged target treatment sites on the image display, following treatment of a tagged target treatment site, removing, altering, or replacing the corresponding overlay on the image display to indicate the tagged target treatment site has been treated.
 2. The medical treatment method of claim 1, wherein tagging target treatment sites with respect to the image includes receiving user input identifying the target treatment sites.
 3. The medical treatment method of claim 1, wherein tagging target treatment sites with respect to the image includes using computer vision to recognize the target treatment sites in the image and tagging the recognized target treatment sites.
 4. The medical treatment method of claim 1, wherein indicating a tagged target treatment site has been treated includes receiving user input identifying that a given target treatment site has been treated.
 5. The medical treatment method of claim 1, wherein indicating a tagged target treatment site has been treated includes using computer vision to recognize that a given target treatment site has been treated.
 6. The medical treatment method of claim 4, wherein indicating a tagged target treatment has been treated further includes receiving input from a treatment device recognized as in proximity to the target treatment site signaling that treatment has been performed by the device. 